JPH0693893B2 - Intracorporeal ultrasound diagnostic device - Google Patents

Description

Description: TECHNICAL FIELD The present invention relates to an intracorporeal ultrasonic diagnostic apparatus for performing both ultrasonic diagnosis and puncture performed by inserting it into a body cavity.

[Prior Art] Conventionally, there is a method of performing an ultrasonic guided puncture into a deep organ such as the pancreas using an extracorporeal ultrasonic diagnostic apparatus, but it is necessary to pierce the needle deeply and damage blood vessels and other organs. Since it is dangerous and the resolution of the ultrasonic tomographic image is low, it is difficult to puncture the target site accurately. Therefore, it is possible to use an ultrasonic diagnostic device in the body cavity, and by performing ultrasonic guided puncture in the body cavity, using a high-resolution ultrasonic tomographic image as a guide,
When puncturing a needle, the depth of puncturing the needle is short, so that complete and reliable puncture can be performed. Examples of these devices include JP-A-56-158646 and Japanese Patent Application No. 58-182838.
In JP-A-56-158646, the ultrasonic probe and the puncture needle lead-out opening are fixed in a line in the axial direction at the tip of the insertion part of the endoscope, and the puncture is made inside the insertion part. A channel for inserting the needle is formed, and a puncture needle raising device is provided at the tip of the insertion portion. A puncture needle is introduced through the insertion channel so that it projects from the tip of the endoscope.In Japanese Patent Application No. 58-182838, an endoscope provided with an ultrasonic probe at the insertion portion and this insertion portion And an endoscope provided with a puncture guide for guiding a puncture needle introduced separately from the endoscope, which is formed toward the inspected region of the ultrasonic probe while penetrating the distal end of the ultrasonic probe. I have. Then, the both endoscopes are inserted into a body cavity, and ultrasonic diagnosis is performed from inside the body cavity to puncture the target site while grasping the state of the body cavity wall and the inside of the organ.

[Problems to be Solved by the Invention] In the prior art, in JP-A-56-158646, since the ultrasonic probe and the puncture needle outlet are arranged in a line at the tip of the insertion portion, the tip forming portion is extremely However, in Japanese Patent Application No. 58-182838, it is not possible to puncture without inserting two endoscopes for ultrasonic diagnosis and puncture needle delivery together. It was about giving pain.

The present invention has been made focusing on such problems,
An object of the present invention is to provide a puncturable intracorporeal ultrasonic diagnostic apparatus capable of reducing the pain of a patient at the time of insertion into / extraction from a body cavity by shortening the distal end configuration portion except when performing puncture. To do.

[Means for Solving Problems] In this device, as shown in FIG. 1, the ultrasonic probe 8 and the puncture needle lead-out opening 13 are provided in the distal end forming portion 3 in the endoscope insertion portion 2.
The ultrasonic probe 8 that moves forward and backward by the slide mechanism 38 of the operation unit 4 is provided so as to move between the position where the front surface of the puncture needle lead-out opening 13 is covered and the position where it is exposed. Puncture needle lead-out opening 13
Are formed so as to project on the ultrasonic image.

[Operation] In this device, the slide mechanism 38 of the operating portion 4 is moved forward to move the ultrasonic probe 8 from the position where the front surface of the puncture needle outlet opening 13 is covered to the position where the front surface is exposed, thereby leading out the puncture needle. The puncture needle 14 can be projected from the opening 13 onto the ultrasonic image.

[Embodiment] Each embodiment of the present invention will be described below with reference to the drawings.

2 to 6 show an intracorporeal ultrasonic diagnostic apparatus showing a first embodiment of the present invention. The endoscope 1 is provided with an elongated flexible insertion portion 2 to be inserted into a body cavity, a distal end forming portion 3 is formed at the tip of the insertion portion 2, and a rear end is formed at the rear end. An operation unit 4 is provided. The operation section 4 has a universal cord 7 having an eyepiece 5 for observing the subject in the body cavity and a connector 6 connected to a light source device (not shown) at the rear end.
And are attached to form an endoscope 1.

The tip forming section 3 is composed of a tip forming section A3a and a tip forming section B3b, and an ultrasonic probe 8 having an ultrasonic transmitting / receiving surface oriented in a side direction is attached to the tip forming section A3a. The ultrasonic probe 8 interposes a damper material 9,
The axial direction of the insertion portion 2 forms an electronic linear scanning type ultrasonic probe 8 which operates in the scanning direction and the scanning range S. Further, two slide coils 10 for sliding back and forth in the axial direction are fixed to the rear end of the tip forming portion A3a, and the other end of the coil 10 communicates with the inside of the insertion portion 2 and is connected to the operation knob A11 of the operation portion 4. It is connected. Further, the ultrasonic probe 8 is connected to a signal cable 12 which is inserted through the insertion portion 2, and is connected to an ultrasonic transceiver (not shown). Next, the tip forming portion B3b is provided with a puncture needle lead-out opening portion 13 having an opened side surface. This puncture needle exit opening
Reference numeral 13 denotes an opening through which the needle tip 14a of the puncture needle 14 is obliquely led out in the direction to be inspected by the ultrasonic probe 8, and communicates with a guide hole 15 formed in the rear part of the tip forming portion B3b, and this guide is formed. The hole 15 is opened through the guide tube 16 to the insertion port 17 located in the operation portion 4. Furthermore, the tip component A3a
The slide coil 10 is moved by operating the operation knob A11 of the operation section 4 so as to overlap the upper part of the tip forming section B3b. The puncture needle 14 has a hard needle tip 14a on the tip side.
And a flexible puncture tube 14b provided subsequent to the needle tip 14a. The puncture tube 14b is inserted through the guide tube 16 and is connected via an insertion port 17 to a base 18 as a device connection port. Above mouthpiece
A syringe 19 for injecting a drug solution or the like and sucking mucus or the like in the puncture target site B in the body cavity can be attached to or detached from the device 18. The puncture needle 14 has a puncture needle guide mechanism 20 so that the projection angle of its needle tip 14a can be adjusted. The puncture needle guide mechanism 20 is located in the puncture needle lead-out opening portion 13, and a raising base 21 for adjusting the projection angle of the needle tip 14a is provided with a pivot 22.
It is provided so as to be rotatable around. This raising base 21 has a guide surface 23 for abutting the side surface of the puncture needle 14, and by adjusting the angle of this guide surface 23, the needle tip 14a
It is designed to deflect. Further, the distal end side of the operation wire 24 is fixed to the raising base 21, and the proximal end side of the operation wire 24 is inserted into the insertion portion 2 to be guided to the operation portion 4 and wound around the pulley 25 to be operated by the operation knob. It is connected to B26. Then, by operating the operation knob B26, the pulley 25 is rotated and the operation wire 24 is pulled, so that the raising base 21 rotates about the pivot shaft 22 according to the amount of pulling, and the puncture needle 14
Is moved to face the body cavity wall A.

An observation optical system 27 having a visual field range H in the direction to be inspected by the ultrasonic probe 8 and an illumination optical system for giving illumination light from a light source device (not shown) to the subject are provided in the tip forming section B3b.
28, and an air / water supply nozzle 29 and a suction port 30 for washing the observation optical system 27 when the observation optical system 27 is soiled with dirt or the like.

In the intracorporeal ultrasonic diagnostic apparatus configured as described above, first, the shortest FIG. 3 (A) in which the distal end constituent portion A3a and the distal end constituent portion B3b of the distal end portion in the insertion portion 2 of the endoscope 1 overlap and coincide with each other.
The tip forming portion 3 in the state shown in (B) is inserted into the body cavity. Then, while performing the visual observation with the eyepiece 5 of the operation unit 4 via the observation optical system 27, the operation knob A11 arranged on the operation unit 4 is slid forward. At this time, the slide coil 10 communicating with the operation knob A11 moves forward,
Tip component A3 that was fixed to the tip of slide coil 10
a slides forward, and along with this, the signal cable 12 also slides forward. Next, when the tip forming portion A3a reaches the target site in the body cavity, the transmitting / receiving surface of the ultrasonic probe 8 is closely fixed to the surface of the body cavity wall A to be inspected. In this state, when an ultrasonic transmitter / receiver (not shown) is operated to perform electronic linear scanning of ultrasonic waves by the ultrasonic probe 8,
Based on the received ultrasonic echo, the ultrasonic diagnostic layer image within the scanning range S is displayed on a display (not shown).
If the puncture target site B is found in the tomographic image,
The needle tip 14a of the puncture needle 14 is preliminarily provided with a guide surface 23 of the raising base 21 so that the protrusion angle corresponds to the depth of the puncture target site B.
When the pulley 25 is rotated by operating the operation knob B26 provided in the operation unit 4 in the state where the pulley 25
The operating wire 24 that had been wrapped around the
The raising base 21 rotates around the pivot 22 of 21 to adjust the angle. (As shown in FIGS. 4A and 4B) Then, while confirming the visual field range H with the observation optical system 27, the puncture tube 14b located at the insertion port 17 of the operation unit 4 is pushed in and the needle tip is pushed. 14a pierces the body cavity wall A. Then, an ultrasonic echo is generated by the puncture needle 14, and it is confirmed that the needle tip 14a enters the scanning range S of the ultrasonic probe 8 in the ultrasonic tomographic image displayed by the display. Push the needle tip 14a forward to the part B. When the needle tip 14a reaches the puncture target site B, the base 18 at the rear end of the puncture tube 14b.
A syringe 19 is attached to the device to inject a drug solution or the like and suction mucus or the like. When the injection or suction of the syringe 19 is completed, the operation opposite to that at the time of puncture, that is, the syringe 19 is removed from the base 18 of the puncture tube 14b, and the puncture tube 14b is pulled to move the needle tip 14a to the guide surface 23 of the elevator 21. The raising base 21 is rotated by operating the operation knob B26, which is the reverse of that at the time of puncturing.
The raising base 21 is housed in the space of, and by pulling the slide coil 10, the tip forming portion A3a and the tip forming portion B3b overlap each other.
In this state, the endoscope 1 is pulled out from the body cavity.

Even when the puncture is not performed only by diagnosing the ultrasonic tomographic image in the body cavity, the tip forming section A3a and the tip forming section B3b are similarly used in the shortest state.

As described above, in the present embodiment, the distal end component in the insertion portion of the endoscope is inserted into the body cavity, and only when the ultrasonic diagnosis is performed, the length becomes short, and the ultrasonic diagnosis and the puncture are combined. When the operation is performed, the distal end constituent portion slides and becomes longer, so that the operability into the body cavity is improved and the pain to the patient can be reduced.

Next, FIG. 7 shows a second embodiment.

In this embodiment, the distal end portion of the insertion portion 2 is shown. A tip forming portion 3 is formed on the tip portion from a tip forming portion A3a and a tip forming portion B3b. As in the first embodiment, the upper tip forming portion A3a is composed of the ultrasonic probe 8 with the ultrasonic transmitting / receiving surface oriented in the side direction and the damper material 9 interposed therebetween. However, an inclined surface A31 that is inclined so that the puncture needle 14 is directed toward the puncture needle target portion B of the body cavity wall A is formed as a guide at the rear end of the tip forming portion A3a. The front end is fixed and the rear end is connected to the operation knob A11 of the operation unit 4 as in the first embodiment. Then, it slides on the opening 32 of the tip forming portion B3b so as to overlap. Further, unlike the structure of the first embodiment, the tip forming portion B3b is composed of an upper portion and a lower portion in cross section. A space between the upper part and the lower part is connected in parallel with the guide hole 15 and becomes a puncture needle lead-out opening 13 which is larger toward the front. The lower part is a guide hole 15
A curved surface 33 is provided which is parallel to one surface and is smoothly inclined forward. Further, in the upper part, an observation optical system 27, an illumination optical system (not shown), an air / water feeding nozzle, a suction port, etc. are arranged side by side in parallel with the axial direction, and further, a tip face forming portion A3a is slid backward and a guide surface 34 and a tip end. It is composed of an inclined surface B35 fitted to the inclined surface A31 at the rear end of the constituent portion A3a and an inclined surface C36 of the puncture needle lead-out opening 13 through which the puncture needle 14 is led out. Then, the puncture needle 14 is inserted through the guide hole 15 and the puncture needle lead-out opening portion is formed.
It is derived from 13 along the curved surface 33. That is, in this embodiment, the raising base, the pivot, the operation wire, the pulley, the operation knob B and the like, which constitute the puncture needle guide mechanism of the first embodiment, are removed. The other configurations are similar to those of the first embodiment, and therefore the same reference numerals are given and detailed description thereof is omitted.

In this embodiment, when the insertion section 2 is inserted into the body cavity, the operation section 4
The ultrasonic probe 8 is also advanced by sliding the operating knob A11 of the frontward direction forward, the puncture needle 14 is led out from the puncture needle lead-out opening 13 of the tip forming portion B3b, and after the tip forming portion A3a along the curved surface 33. The inclined surface 31 at the end is used as a guide to rise in the direction of the body cavity wall A and puncture the puncture target site B.

By doing so, since the puncture needle guide mechanism 20 as in the first embodiment is not provided in the distal end constituting portion B3b, the outer diameter of the insertion portion can be made smaller than that in the first embodiment, which is painful to the patient. It can be reduced.

FIG. 8 shows a third embodiment. In this embodiment, the ultrasonic probe 8 is of the electronic sector scanning type, and the operating range S of the ultrasonic probe 8 is widened. The other configurations are similar to those of the first embodiment, and therefore, the same reference numerals are given and detailed description will be omitted.

In this embodiment, as compared with the first embodiment, the scanning range S of the ultrasonic probe 8 expands in a fan shape, so that the range of blind puncturing can be reduced when puncturing, so that the safety is improved and the length of the tip forming portion is increased. Since the length of the sonic probe is shorter than that of the first embodiment, the pain to the patient can be reduced.

9 to 10 show a fourth embodiment, which is a modified example of the second embodiment, in which the inclined surface 31 at the rear end of the distal end forming portion A3a located at the distal end portion of the insertion portion 2 is shown. The notch 37 is provided in the central portion of the. Further, it differs from the second embodiment in that the observation optical system 27 and other portions above the tip forming portion B3b are inclined so that a part of the visual field range H can be easily seen. The other configurations are similar to those of the second embodiment, and therefore, the same reference numerals are given and detailed description will be omitted.

Further, FIGS. 10A to 10C are views showing respective states of FIG.

FIG. 10 (A) shows a state diagram of the shortest tip forming portion 3 used only for insertion / extraction in the body cavity and ultrasonic diagnosis when the tip forming portions A3a and B3b coincide and overlap. As shown, the inclined surface A31 at the rear end of the tip forming portion A3a and the inclined surface B35 of the tip forming portion B3b are fitted together. It shows the first puncture angle θ1 formed by the puncture needle 14 and the tip forming portion A3a when it is slid to the position. (C) is the tip component A3
It shows the second puncture angle θ2 formed by the puncture needle 14 and the tip forming portion A3a when a is slid to the maximum.

In the intracorporeal ultrasonic diagnostic apparatus having this configuration, when the insertion portion 2 of the endoscope 1 is inserted or withdrawn, the distal end constituent portion A3a is arranged above the distal end constituent portion B3b and overlapped with each other (see FIG. 10A). It is done in the position. Next, in order to perform ultrasonic diagnosis and perform puncture, after the tip forming portion A3a is slid forward by the operation knob A11 provided in the operation portion 4 to the position of B in FIG. 10, the puncture needle 14 is led out. The opening 13 projects along the smooth curved surface 33 from the inside of the notch 37 at the rear end of the tip forming portion A3a, and
Appears in the scanning range S at the puncture angle θ1 of. When the tip forming portion A3a is further slid forward, the position becomes the position of (C) in FIG. 10 and the puncture needle 14 is projected in the scanning range S at the second puncture angle θ2. In this way, the angle with the puncture needle 14 is arbitrarily changed by sliding the tip constituent part A3a back and forth.

In this embodiment, the puncture angle can be freely adjusted by changing the slide position of the distal end forming portion A3a without the puncture needle guide mechanism unlike the first embodiment. It is thin and can puncture the target more reliably than in the second embodiment.

As described above, in these embodiments, the tip end portion A3a is provided with the ultrasonic probe 8 on the side surface, but in order to improve the close contact between the ultrasonic probe 8 and the body cavity wall A, the balloon is not shown. The attachment may be further improved by attaching the. The balloon is used by filling it with an ultrasonic transmission medium.

[Advantages of the Invention] Except when puncturing is performed by ultrasonic diagnosis, the ultrasonic probe and the puncture needle lead-out opening of the distal end forming portion are configured to overlap with each other when the insertion portion is inserted into or removed from the body cavity. Therefore, by making the tip forming portion shorter by that much, the operability of insertion into and removal from the body cavity is improved, and the pain to the patient is also reduced.

[Brief description of drawings]

FIG. 1 is a principle diagram of an intracorporeal ultrasonic diagnostic apparatus of the present invention, FIG.
FIGS. 1 to 6 show a first embodiment of the present invention, FIG. 2 is an overall view of an ultrasonic diagnostic apparatus in a body cavity, and FIG. 3 is a state diagram when the tip forming portion is shortest (A). Is a plan view, (B) is a side view, (C) is a cross-sectional view taken along the line AA of (A), FIG. 4 is a state diagram at the time of puncturing with the distal end constituent part slid forward, (A) is a plan view, (B) is a side view, FIG. 5 is a plan view further enlarging (A) of FIG. 4, FIG. 6 is a side sectional view further enlarging (B) of FIG. 4, and FIG. FIG. 8 is a side sectional view of the tip forming part at the time of puncturing of the embodiment, FIG. 8 is a sectional view of the tip forming part at the time of puncturing of the third embodiment, and FIGS. 9 to 10 are the fourth embodiment and FIG. FIG. 10A is a plan view of the tip forming portion during puncturing, and FIGS. 10A, 10B, and 10C are state diagrams of the tip forming portion. 1 ... Endoscope, 2 ... Insertion part, 3 ... Tip configuration part, 4 ... Operation part, 8 ... Ultrasonic probe, 10 ... Slide coil, 11 ... Operation knob A13 ... Puncture needle Drawout opening, 14 ... Puncture needle, 20 ... Puncture needle guide mechanism, 37 ... Notch

Claims (3)

[Claims] 1. An ultrasonic probe having an ultrasonic transmission / reception surface directed laterally to a distal end forming portion of an insertion portion to be inserted into a body cavity,
In the endoscope provided with a puncture needle lead-out opening that guides the puncture needle in a direction to be inspected by the ultrasonic probe, the ultrasonic probe covers a front surface of the puncture needle lead-out opening. Inside the body cavity, wherein an ultrasonic probe slide mechanism is provided for moving the ultrasonic probe from a position to a second position where the ultrasonic probe is located in front of the puncture needle lead-out opening in the insertion axis and exposes the puncture needle lead-out opening. Ultrasonic diagnostic equipment. 2. The intracorporeal ultrasonic diagnostic apparatus according to claim 1, wherein a puncture needle guide mechanism for adjusting the puncture angle of the puncture needle is provided in the puncture needle lead-out opening. 3. The intracorporeal cavity according to claim 1, wherein a cutout portion is provided in the inclined portion at the rear end of the ultrasonic probe so that the puncture angle can be adjusted by advancing and retracting the ultrasonic probe. Sound wave diagnostic equipment.